[Martina]

I have finally got to a point where I am very stable, not extremely depressed, not extremely impulsive. I lost my job, but I still didn't fall off the deep end like I could have. I'm feeling pretty good. I also have Borderline Personality Disorder, so some of my issues just won't go away with medications. We're working on all that.

Anyway...my blood glucose levels have been up & down the past few months. At my latest family doc appointment, they said my numbers don't really qualify for a diagnosis of diabetes or even pre-diabetes at this point, but that based on my spotty high numbers, my obesity, and my family history (my dad), I am at very high risk of developing diabetes at some point in my life. I was told to diet & exercise, lose as much weight as possible.

I've gained 60 pounds on the Zyprexa, 50 within only a few months. I know part of it is my own laziness and binge eating, but a lot of it is the increased appetite from the Zyprexa.

So anyway...based on my weight gain and blood glucose levels, my psych nurse (does meds & therapy) wants to switch me from Zyprexa to Invega, and from Lamictal to Topamax. What do you think?

She suggested the Topamax in an email last week. I see her on Tuesday and I need to decide what to tell her. The funny thing is, I actually mentioned Topmax to HER about 5-6 months ago when I was struggling with my weight and someone online told me that Topamax has a weight loss side effect. But she told me that Lamictal was the #1 drug out there for Bipolar II, and I think she thought I was just looking for an easy way to lose weight. Well, now, I think she realizes just how hard it is for me to lose weight.

But do I dare risk the change? What if I become unstable again? What if I get suicidal? I would love to lose weight and reduce my risk of diabetes, but at what cost?

Have any of you been on Topamax? What is your opinion of it? Were you ever on Lamictal - which one worked better/worse for you? I know every person is different, just looking for examples.

I'm already down to a half-dose of the Zyprexa and I plan to wean off it this Wednesday. Then give it a week or two and see what happens with the Invega - I'm already up to a therapeutic dose of that.

If I do decide to do the Lamictal/Topamax switch-when should I do it? Should I wait a few weeks after the Zyprexa/Invega switch? How long?

What a difficult decision. I totally empathize with the weight issue. I would say since you are already changing to topomax, do it slowly and it would seem that giving a few weeks between switching meds would be important so you have time to observe how the first switch is affecting you. Good luck with the change.

[tracy33]

My pdoc added Topamax while I was still taking Lamictal. I still take both. Topamax has been my wonder drug. It leveled out my moods better than anything else and I lost close to 70 pounds.
My pdoc understood how the weight gain was a cause of my depression, so she wasn't hesitant at all to put me on Topamax. In fact, she just increased it because I was eating alot and gained some weight ( and I mentioned I had ups and downs).
It has it's side effects, but most go away after a while. It decreases the effectiveness of birth control pills, too. My husband had a vasectomy to solve that problem.
So I would definately give it a shot. You could stay on both drugs at the same time.

[Martina]

Originally Posted by tracy33

It decreases the effectiveness of birth control pills, too.

Seriously?? Crap! Do you know about the Mirena IUD? I'll have to Google it. I didn't see that warning on the Topamax website, but I only read the "Important Safety Information" stuff, not the full patient insert. Maybe I need to read the whole thing.

I absolutely can NOT afford to get pregnant right now. For SOO many reasons.

Then again...haven't had sex in 5 months, so maybe I don't really need bc anymore...sigh. That's a whole other issue.

---

Edited to add: Got this from the full prescribing info:

Oral Contraceptives:

In a pharmacokinetic interaction study in healthy volunteers with a concomitantly administered
combination oral contraceptive product containing 1 mg norethindrone (NET) plus 35 mcg ethinyl estradiol (EE), TOPAMAX®

given in the absence of other medications at doses of 50 to 200 mg/day was not associated with statistically significant
changes in mean exposure (AUC) to either component of the oral contraceptive. In another study, exposure to EE was
statistically significantly decreased at doses of 200, 400, and 800 mg/day (18%, 21%, and 30%, respectively) when given
as adjunctive therapy in patients taking valproic acid. In both studies, TOPAMAX

® (50 mg/day to 800 mg/day) did not
significantly affect exposure to NET. Although there was a dose dependent decrease in EE exposure for doses between
200-800 mg/day, there was no significant dose dependent change in EE exposure for doses of 50-200 mg/day. The clinical
significance of the changes observed is not known. The possibility of decreased contraceptive efficacy and increased
breakthrough bleeding should be considered in patients taking combination oral contraceptive products with TOPAMAX®.
Patients taking estrogen containing contraceptives should be asked to report any change in their bleeding patterns.

Contraceptive efficacy can be decreased even in the absence of breakthrough bleeding.

So if I'm reading it correctly, it has someting to do with the estrogen. I'm using the Mirena IUD which has progestin-only. Do you think I'm safe? How can I find out? Like I said...a baby is NOT an option at this point in my life!! I guess I can just ask my husband to start using condoms again.

[netsavy006]

I think if you can I'd take the Lamictal and the Topamax together. That's because you report in another post that Lamictal is working so why mess with what is working. If for some reason you can't add Topamax and have to make a choice between the two, then I don't know which to pick but I'd think long and hard about what's important before deciding to switch meds. I was on this road myself about a month ago wanting to switch one of my medications and it probably would of been one of the worst mistakes of my life. So all I can say in the end is find out if you can add Topamax to the cocktail and if not think long and hard before making changes because you don't know what you may (or may not) like the change.

Best of luck.

[tracy33]

Both my pdocs stressed the birth control thing. My past pdoc was ready to give me the script for Topamax a few times and then ripped it up in front of me saying " Oh, I forgot, you're on the pill."
The most recent one told me about it and that's when we said we'd use condoms and my husband would get the vasectomy. That's how badly we both wanted me to lose the weight.
I don't know about what you're using right now for birth control, I don't know how you would find that out. I hear ya about not having sex. My libido has been so low since Prozac was added, in fact, my pdoc advised me to just go off it. I think I'll give that a try.
Have you heard about endometrial ablation? My family doctor is referring me to a gyno to talk about it. It's because I'm always on my period it seems. Anyway, I think that cuts you're chances of having a kid down to nothing.

[sebontheweb]

In any case, I would change only one med at a time.

Zyprexa is the first one to change. In my case, I gained 50lbs in less than 6 months. If you have been stable for a while, you might not need an atopic antipsychotic anymore.

As for the mood stabilizer lamictal is a good one and I would wait for a while before deciding to change after stopping/changing the Zyprexa.

Best of luck.

[Slick399]

Martina,

Only change one med at a time. Otherwise you won't know what is going on in your body.

Slick

[Martina]

My doc agreed, just one change at a time. I was confused why she mentioned the Topamax when we're already going off the Zyprexa. But she does only want to do one at a time.

So I'm off the Zyprexa completely, as of two days ago! I'm really happy, I hate how much weight I've gained. I gained 50 pounds the first 6 months - yes, I was eating bad, but still. They know Zyprexa causes weight gain, so I'm sure not all of it was my fault.

Only thing I've noticed so far is I'm not sleeping as much, but that is a GOOD thing for me - lately I've been sleeping (or just laying in bed) for up to 12 hours a day. Not good. Sometimes I leave my 3 year old daugther watching PBS while I sleep. Not good! So getting less sleep would be a good thing.